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Menopause Abnormal Vaginal Bleeding in Elderly Women

Menopause is a stage in a woman’s life when menstruation ceases due to hormonal changes. Ovulation does not occur and pregnancy is therefore not possible. It is preceded by a transition phase, between the reproductive years and menopause, where a woman may experience erratic menstruation. This is known as perimenopause

Once menopause sets in though, monthly bleeding (menses or periods) should cease altogether. Sometimes a woman who has entered menopause experiences vaginal bleeding. This is not uncommon and can often be a cause for concern if it is a heavy bleed that is recurrent or persistent. This abnormal vaginal bleeding in menopausal women is not menstruation (periods).

The bleeding may or may not be accompanied by other symptoms like pain and vaginal discharge. The presence of these other symptoms are important indicators of the underlying cause. However, it should not detract from the fact that vaginal bleeding even without pain and discharge can be due to serious diseases. The concern for older women is that some of the more life threatening causes of abnormal vaginal bleeding is more likely to arise in seniors.

Causes of Bleeding In and After Menopause

Abnormal vaginal bleeding with menopause arises for several reasons. It can arise with hormone changes, growths in the uterus, age related changes in the vagina or uterus and infection of the female reproductive system.

The most common cause of abnormal vaginal bleeding in menopause is hormone replacement therapy (HRT). Bleeding arises as a consequence of high estrogen levels with HRT but can also start after HRT is stopped. Bleeding which occurs with HRT cessation is short lived though.

Atrophic vaginitis is a condition that develops when the estrogen levels drop. This is seen with menopause or after stopping HRT. The vaginal wall thins and becomes inflamed. Usually bleeding does not occur spontaneously. Rather it arises after injury to the vagina like during intercourse or certain diagnostic procedures such as a Pap smear or biopsy.

Growths such as uterine polyps and uterine fibroids also cause vaginal bleeding, irrespective of whether a woman is in her reproductive or menopause years. Fibroids stem from deeper in the uterus wall and tends to cause heavier bleeding than polyps. Overall however, the bleeding with polyps and fibroids are usually lighter than a period.

Infections of the reproductive organs (pelvic inflammatory disease) or the urethra and bladder (urinary tract infection) can lead to abnormal bleeding in menopause. It is important to note that while pelvic inflammatory disease causes vaginal bleeding, a UTI presents with bleeding from the urethra although it is at times difficult to differentiate.

Cancer of the vulva, vagina, cervix, uterus or ovaries may all lead to abnormal vaginal bleeding. This is the most serious cause and the main concern for most women. The risk of many of these cancers increase with menopause and regular screening should therefore be considered.

Endometrial hyperplasia is overgrowth of the endometrium. Often this overgrowth is a precancerous change meaning that cancer is likely to develop in the near future. Early diagnosis and treatment can therefore prevent cancer.

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